294例HIV感染者/艾滋病患者皮肤黏膜表现及流行病学特征

Mucocutaneous manifestations and epidemiological characteristics in 294 patients with HIV infection or AIDS

目的分析294例人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者皮肤黏膜表现及流行病学特征。方法选择医院2014年1月-2020年5月诊治的294例HIV/AIDS患者,收集流行病学资料、实验室检查数据,分析其流行病学特征和皮肤黏膜疾病种类、特征。结果HIV/AIDS病例主要来源于皮肤科及高效抗反转录病毒治疗(HAART)门诊,男性居多,年龄以21~49岁为主,多处于未婚,文化程度多为初中及以下,传播途径以同性或异性性传播途径为主,职业以农民/工人为主;HIV/AIDS患者皮肤黏膜表现以感染性和炎症性皮肤病为主;HIV/AIDS患者中118例无皮肤病表现,并发一种皮肤病表现有98例,并发多种皮肤病的有78例,随着CD_(4)^(+)T淋巴细胞计数水平升高,皮肤病的发病率及并发疾病数量逐渐降低;294例HIV/AIDS患者有204例患者获得HIV-1 pol区基因序列,患者感染的HIV-1分布在5个不同亚型,其中以CRF01-AE、B′亚型居多,不同年龄、性别患者基因亚型比较无统计学意义;HIV/AIDS患者1年累计生存率为80.27%,单因素及多因素Cox回归分析均证实性别为女、未加入高效逆转录病毒治疗(HAART)、年龄≥50岁、确诊时病期为AIDS均为导致HIV/AIDS患者死亡的影响因素(P<0.05)。结论HIV/AIDS患者皮肤表现复杂,HIV基因亚型以CRF01-AE、B′亚型为主,免疫功能越差,越易并发皮肤黏膜疾病,生存率受年龄、性别、确诊时病期以及HAART治疗影响。

OBJECTIVE To analyze the mucocutaneous manifestations and epidemiological characteristics in 294 patients with human immunodeficiency virus(HIV)infection or acquired immune deficiency syndrome(AIDS).METHODS From Jan 2014 to May 2020,294 HIV or AIDS patients were diagnosed and treated in the hospital.Epidemiological data and laboratory test data were collected to analyze the epidemiological characteristics,types and characteristics of skin and mucosal diseases.RESULTS The HIV or AIDS cases were mainly from Dermatology and HAART outpatient clinics.Most of them were male,21-49 years old,unmarried,with the education level of junior high school or below.The transmission route was mainly homosexual or heterosexual transmission,and the occupation was mainly farmers/workers.The skin and mucosa manifestations of HIV or AIDS patients are mainly infectious and inflammatory skin diseases.In this study,118 patients showed no skin disease,98 patients with one type of skin disease,and 78 patients with multiple skin diseases.As the CD_(4)^(+)T lymphocyte count increased,the incidence of skin diseases and the number of complications decreased.HIV-1 pol gene sequence was obtained from 204 in 294 patients,which involved 5 different subtypes,with the majority of CRF01-AE and B′subtypes.There was no significant difference in genotype among patients of different age and different gender.The 1-year cumulative survival rate of the patients enrolled was 80.27%.Univariate analysis and multivariate Cox regression analysis confirmed that female,no highly active anti-retroviral therapy(HAART),age≥50 and stages of disease at diagnosis were independent risk factors for death of patients with HIV infection/AIDS(P<0.05).CONCLUSION The skin manifestations of HIV or AIDS patients are complex,and the HIV gene subtypes are mainly CRF01-AE and B′subtypes.The worse the immune function is,the more likely it is to be complicated with skin and mucosal diseases.The survival rate is affected by age,sex,disease stage at diagnosis and HAART treatment.